Nursing guideline helps overcome stigma of Methadone

TORONTO,
Dec. 1, 2009 – A pregnant woman walks into a hospital in early labour. She feels
nauseated and achy; her contractions are 20 minutes apart. There is more to her
story than meets the eye. She is on methadone maintenance therapy (MMT) and
wasn’t able to pick up her daily dose at the pharmacy this morning. Although her story may be hard to believe she
is one of the estimated 17,000 clients in Ontario currently receiving MMT. Methadone is a legal substitute therapy for
patients addicted to opioids, such as heroin, and prescription narcotics like
OxyContin.

For
nurses who encounter MMT clients during the course of their work, the recently
published Registered Nurses’ Association of Ontario (RNAO) MMT guideline is a welcome
resource. The guideline ensures that nurses have the latest evidence-based
information to enhance their practice and strengthen and improve care for MMT
clients.

The
costs of untreated opioid addiction include health care, law enforcement,
social assistance and loss of economic productivity. In the past, heroin has been the most
commonly misused opioid in Canada however, that pattern is changing due to the increased availability of
prescription opioids. “A lot of people
think it’s only street drug users who take methadone but that’s simply not
true. I’ve had clients... addicted to opiates after dental or back surgery,”
explains Janice Price, a public health nurse who contributed her expertise to
this guideline.

Nurses are
an integral part of the health-care system and in a unique position to address
stigmas and to reduce barriers to care. They are often the first contact that people have with the health-care
system and – even if they do not work directly in addiction areas, they do
encounter MMT clients especially in the Emergency and Maternity
departments. This guideline allows them
to recognize the signs and symptoms of substance abuse, understand treatment
options and have an appreciation for the stigmas and biases often associated
with this population. Irmajean Bajnok,
director of the International Affairs and Best Practice Guideline Program at
RNAO, says the guideline recommends that nurses consider social determinants of
health when carrying out assessments and interventions. She says, “factors such as housing, income,
social status and stress impact the health of all people, but their influence
can be more pronounced in this group.”

According
to Margaret Dykeman, manager of a primary care clinic and leader of the panel
who developed the guideline, “People on methadone can live a normal life. Our
goal is to get them feeling like a human being again, getting them back to
work, getting their kids from social services and for new mothers improving the odds that they have a normal baby that’s not
addicted or damaged by drugs.” The MMT follows the principles of the harm
reduction model, which essentially says a practical and compassionate approach
towards addiction is the most effective way of treating people.

The
development of this guideline started in January 2008 with a multi-disciplinary
panel made up of nurses and other health-care professionals from various
settings including hospitals, community, corrections and academic universities.

Quick Facts:

Addiction
is characterized by the compulsive and continued misuse of a substance, despite
its overtly negative consequences. Addiction makes it extremely difficult to stop using a substance,
despite having tried quitting one or more times.

Harmful
consequences of addiction consist of physical illness, family breakdown,
economic issues, criminal involvement and a high risk of overdose leading to
death.

Methadone
is a safe, synthetic opioid which prevents or reduces the withdrawal effects of
opioid dependence. It is commonly used
to treat dependence on other opioid drugs such as heroin, codeine and morphine. It’s treatment not a cure.

Women
who are addicted to opioid drugs and who are pregnant are often treated with
methadone to protect their fetus, since opioid withdrawal can increase the risk
of miscarriage or premature birth.

MMT
is part of a harm reduction model which recognizes that substance misuse occurs
and will continue to occur within society and it seeks to provide appropriate
and accessible services without the barriers of stigma and negative labels.

MMT
as a harm reduction strategy seeks to reduce misuse of drugs, improve quality
of life, retain people in treatment programs, reduce crime, decrease risk of
death from overdoses, improve pregnancy outcomes and improve social health and
productivity.

The Registered Nurses’ Association of Ontario
(RNAO) is the professional association representing registered nurses in
Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted
excellence in nursing practice, increased nurses’ contribution to shaping the
health-care system, and influenced decisions that affect nurses and the public
they serve.

RNAO’s
ambitious Best Practice Guidelines Program, funded by Ontario’s Ministry of
Health and Long-Term Care, was launched in 1999 to provide the best available
evidence for patient care across a wide spectrum of health-care areas. The 42
guidelines developed to date are a substantive contribution towards building
excellence in Ontario’s health-care system. They are available to nurses, other
health-care professionals and organizations across Canada and abroad. To learn
more about RNAO’s Nursing Best Guidelines Program or to view these resources,
please visit http://rnao.ca/bpg[2].